Ohio Probate Form - Report Of Distribution
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1PROBATE COURT OF________________ COUNTY, OHIO
_____________
, JUDGE
________________________________________________
IN THE MATTER OF
____________________
CASE NO.
REPORT OF DISTRIBUTION
Pursuant to the Entry filed on ________________________, ______, the proceeds have been paid as
shown below and on the accompanying vouchers.
Gross Proceeds
$ __________________
Less:
Medical expenses
$ __________________
Reimbursement of suit expenses to _________
______________________________________
$ __________________
Attorney fees to _________________________
$ __________________
Other: _________________________________
$ __________________
Total
$ __________________
Net Proceeds
☐ Deposited pursuant to R.C. 2109.13
Form ____ attached
$ ___________________
☐ Delivered to ___________________________
legal guardian of the estate
$ ___________________
☐ Structured - see documents previously filed
$ ___________________
☐ Other:_____________________________________________________________.
Balance
$ ___________________
_______________________
____________________
Attorney for Applicant
Applicant
Attorney Registration No.______________
ENTRY
The above report of distribution is hereby approved.
____________________________
_______________________________
Date
_______________, PROBATE JUDGE
Print Form
FORM 22.7 - REPORT OF DISTRIBUTION AND ENTRY
Effective Date: January 1, 2015
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